Doctor Visit Becoming A Group Event


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(Sacramento, CA)
Monday, April 28, 2008

At a Kaiser Permanente clinic in Elk Grove a small group of patients with diabetes are meeting in a conference room. They’re taking part in a group patient visit. Today’s topic is diabetes myth or fact. 

This is how it works: Usually about 15 patients with the same illness meet in a classroom setting. They’re taught tips for managing their disease and talk with each other about what works for them. Then their doctor pulls each one aside into a private room to go over lab results and do a brief exam. Melba Strom of South Sacramento got some good news from her physician Dr. Janine Bera.

 “You are doing really really good work with your diet and exercise and that is fabulous, so you should feel really good about yourself – you should get a new piece of jewelry.”

“Oh you know I love jewelry…”
 
Strom has been attending group visits for the last five years. She says she can still see her doctor individually but says this is a nice bonus.

 “You know you’re not alone, you know there’s others that have the same kind of problems, and face the same difficulties and face diabetes.” 
 
Dr. Bera says about 80 percent of her patients with diabetes go to group visits. At the Elk Grove and South Sacramento locations Kaiser reports almost 2,000 people a month attend hypertension, high cholesterol or diabetes group visits. And Dr. Bera says it’s worked for Strom.

“I do see my patients get much better when they go through the class. Since she’s been going to the class her numbers have been completely turning around. So they get encouragement, camaraderie to do better with their diabetes.” 
 
Dr. Bera says the visits are effective for her too. 
  
“Definitely saves time and it’s because diabetes has certain things you need to do that everybody has to do. I would have to say the same thing over and over and over again maybe as many as 15 to 20 times in a day.”
 
These group visits are not new. They’ve been around for 10 years at Kaiser Permanente. They’re now gaining more attention in the health care industry. But for patients, the thought of seeing a doctor in…a group can be alarming.

“Most of us providers and patients have a view of what health care is and a group visit is not what most of us picture.” 
 
That’s Martha Funnell a nurse and diabetes educator at the University of Michigan and past-President of the American Diabetes Association. She says her research shows patients in group visits can lose weight and lower their blood pressure and cholesterol levels. But, it’s not for everyone. 

“I think there are some patients who clearly don’t like being in a group situation.” 
 
And Funnell says there can be potential risks, for instance if patients are forced to attend group sessions or if their medical information is not protected.

So what’s in it for the health plans? Aside from better care they’re interested in the potential to save money. An internal Kaiser study done in the late 90s showed group visits reduced costs by seven percent and hospitalizations went down by twelve percent.  But, independent data is hard to come by for managed care plans. That’s according to Leslie Greenwald a scientist with the research institute RTI International. 

“The piece that’s been elusive is concluding that they save money.”

Still Greenwald says there must be some benefit. 

“There wouldn’t be an awful lot of reason for managed care organizations, like Kaiser, to continue to engage in these tools if they didn’t work.” 
 

She says almost all health plans – whether managed care or fee for service – are testing group patient visits. And, now Kaiser is even piloting an online group visit.